Clinical Depression Is a Strong Predictor of Poor Lumbar Fusion Outcomes Among Workers' Compensation Subjects. Issue 10 (15th May 2015)

• Record Type: Journal Article
• Authors: Anderson, Joshua T.; Haas, Arnold R.; Percy, Rick; Woods, Stephen T.; Ahn, Uri M.; Ahn, Nicholas U.
• Is Part Of: Spine. Volume 40:Issue 10(2015)
• Publication Date: 2015-05-15
• Subjects: workers' compensation -- lumbar fusion -- depression -- biopsychosocial -- return to work -- failed back syndrome -- opioid analgesics -- psychosocial -- risk factors -- predictors -- legal representation -- degenerative; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000863
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective cohort study. Objective: Determine how psychosocial factors, particularly depression, impact lumbar fusion outcomes in a workers' compensation (WC) setting. Summary of Background Data: WC patients are less likely to return to work (RTW) after fusion. Few studies evaluate risk factors within this clinically distinct population. Methods: A total of 2799 Ohio WC subjects were identified who underwent lumbar fusion between 1993 and 2013 using Current Procedural Terminology ( CPT ) procedural and International Classification of Diseases, Ninth Revision ( ICD-9 ) diagnosis codes. A total of 123 subjects were diagnosed with depression before fusion. Subjects with a smoking history, prior lumbar surgery, permanent disability, and failed back syndrome were excluded. The primary outcome was whether subjects returned to work within 2 years of fusion and sustained this RTW for more than 6 months of the following year. To determine the impact depression had on RTW status, we performed a multivariate logistic regression analysis. We also compared time absent from work and other secondary outcomes using χ 2 and t tests. Results: Subjects with preoperative depression had significantly higher rates of legal representation, degenerative lumbar disease, and higher medical costs, and used opioid analgesics for considerably longer before and after fusion ( P < 0.001). Depression group (10.6% [13/123]) and controls (33.0% [884/2676]) met our RTW criteria ( P < 0.001). Preoperative depression was a negative predictor of RTW status ( P < 0.001; odds ratio [OR]: 0.38). Additional predictors included working during same week as fusion (OR: 2.15), age more than 50 years (OR: 0.58), chronic preoperative opioid analgesia (OR: 0.58), and legal representation (OR: 0.64). After surgery, depression subjects were absent from work 184 more days compared with controls ( P < 0.001). Conclusion: Overall, RTW rates after fusion were low, which was especially true for those with pre-existing depression. Depression was a strong negative predictor of postoperative RTW status. Psychological screening and treatment may be beneficial in these subjects. The poor outcomes in this study may highlight a more limited role for fusion among WC subjects with chronic low back pain where RTW is the treatment goal. Level of Evidence: 3 Abstract : Supplemental Digital Content is Available in the Text.Few studies evaluate risk factors for poor lumbar fusion outcomes among the workers' compensation population. We demonstrated that preoperative depression was a strong negative predictor of postoperative return to work status among 2799 Ohio workers' compensation subjects. Preoperative screening for depression and treatment, if necessary, may be beneficial in this population.